Provider Demographics
NPI:1972940633
Name:KELLER, KELLI ANNETTE-ISAACS (DO)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ANNETTE-ISAACS
Last Name:KELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANNETTE
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 GOOD LIFE PL
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-7700
Mailing Address - Country:US
Mailing Address - Phone:859-359-2142
Mailing Address - Fax:859-545-5016
Practice Address - Street 1:410 GOOD LIFE PL
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-7700
Practice Address - Country:US
Practice Address - Phone:859-359-2142
Practice Address - Fax:859-545-5016
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine